Kostas N. Fountoulakis. Bipolar Disorder. An Evidence-Based Guide to Manic Depression
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2 Kostas N. Fountoulakis Bipolar Disorder An Evidence-Based Guide to Manic Depression 123
3 Bipolar Disorder
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5 Kostas N. Fountoulakis Bipolar Disorder An Evidence-Based Guide to Manic Depression
6 Kostas N. Fountoulakis Division of Neurosciences 3rd Department of Psychiatry Aristotle University of Thessaloniki School of Medicine Thessaloniki Greece ISBN ISBN (ebook) DOI / Springer Heidelberg New York Dordrecht London Library of Congress Control Number: Springer-Verlag Berlin Heidelberg 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (
7 To Katerina My sons Nickolas and Ioannis My parents Nick and Olga and parents-inlaw Ioannis and Zoumboulia For without their enduring support, this book would not have been possible to author
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9 Foreword During the latter part of the twentieth century, manic depression emerged as a new focus of research that over time came to achieve an equal status with schizophrenia and depression among mental health professionals. Indeed, because of its complexity and high cost and its flamboyant symptomatology, it now tends to enjoy a privileged status, especially in the minds of those working in the arts and sciences. Manic depression has a number of impressive characteristics. First, it has become almost fashionable to admit that one suffers from this mental disease. Second, there is a widespread belief that it is strongly correlated with creativity. Many famous people announce publicly that they suffer from it, while historical and biographical data suggest that other renowned personalities from the past have been afflicted with the illness. Third, manic depression is one of the very few medical conditions that respond to treatment with a single simple natural element: lithium. This is extraordinary, and the way in which this happens is unique in medicine. This book is a single-authored work. This is rather unusual today, when multiauthored books are the rule. An extremely large amount of work is needed to accomplish such a task, especially when the purpose is to systematically review the literature and try to follow the rules of evidence-based medicine to the extent that the literature permits it. The result, however, is a comprehensive, solid book and not a heterogeneous compilation of book chapters. The various chapters of this book address distinct aspects of the disease, from traditional ones such as the historical perspective to modern approaches like staging. Especially the chapter on biological therapies utilizes a precise methodology in the collecting and ranking of data and agents and thereby provides the reader with the state of the art in a comprehensive way which can rarely be found in a book. I strongly believe that the book will satisfy the most discriminating of readers, including both those seeking an update on a specific aspect of the illness and those whose need is a comprehensive reference. I have no doubt that this book will have a significant impact on the field and will constitute a very important resource for teaching, training and research and provide guidance for everyday clinical practice. vii
10 viii Foreword The hope is that it will also help to upgrade the status of bipolar disorder on the agenda of policy makers and promote awareness of the illness so that the needed resources are allocated both for further research in the field and for the targeted treatment and care of patients and their families. Gothenburg, Sweden Arvid Carlsson October 2014 Nobel laureate in medicine 2000 Emeritus Professor of Pharmacology Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
11 Contents 1 Historical Perspective Antiquity Middle Ages Modern Era References Clinical Description Normal Emotions, Neurobiology and Ethological Considerations The Conceptualization of Bipolar Disorder Bipolar Depression Mania Hypomania Mixed States Psychotic Features Other Clinical Issues The Subjective Experience of Manic Depressive Patients List and Definitions of Symptoms and Signs Mood Psychomotor Disorder Neurocognitive Disorder Thought Disorder Psychotic Features Somatic and Neurovegetative Symptoms Behavioural Disorder References Long-Term Course Predominant Polarity Seasonality Rapid Cycling References ix
12 x Contents 4 Neurocognitive Functioning in Bipolar Disorder: A Comprehensive Review of Recent Data General Neurocognitive Functioning and Intelligence Quotient (IQ) Psychomotor and Mental Speed Attention Learning and Memory Verbal Skills Visuospatial Skills Executive Function Social Cognition and Theory of Mind (ToM) ToM Emotion Processing Emotional Decision-Making Reviews and Meta-analyses Clinical Correlations The Effect of Medication The Effect of Psychotic Symptoms The Effect of Mood Symptoms The Effect of Age and Age at Onset and Personal Psychiatric History The Role of Other Clinical Factors BD-II Long-Term Development of the Neurocognitive Deficit Awareness of the Neurocognitive Deficit Gender and the Neurocognitive Deficit The Neurocognitive Deficit as an Endophenotype for BD Twin Studies Studies on First-Degree Relatives Studies on Mixed Samples of Relatives Reviews and Meta-analyses References The Role of Temperament Historical Perspective References The Bipolar Spectrum References Schizoaffective Disorder References Personality Disorders (Narcissistic, Antisocial, Borderline) References
13 Contents xi 9 Alcohol and Substance Use in BD Patients Epidemiology Epidemiology of Alcohol Use Disorder Epidemiology of Cannabis Use Disorder Epidemiology of Gambling Epidemiology of Methadone Epidemiology of Cocaine Epidemiology of Opioids Epidemiology of Smoking Etiopathogenesis of SUD in BD General Causative Factors and Mechanisms Neurobiology Clinical Issues Clinical Issues Related to Alcohol Use Clinical Issues Related to Cannabis Use Clinical Issues Related to Cocaine Use Clinical Issues Related to Opioid Use Clinical Issues Related to Nicotine Use and Smoking Substance Use and Neurocognitive Disorder Comorbidity Disability Suicidality Legal Issues Treatment References Comorbidity Psychiatric Comorbidity Comorbid Anxiety Comorbid Obsessive Compulsive Disorder (OCD) Comorbid Attention Deficit Hyperactivity Disorder (ADHD) Comorbid Complicated Grief (CG) Comorbid Eating Disorders Various Other Comorbid Conditions Comorbid Psychiatric Disorders and BD-II Medical Comorbidity General Medical Comorbidity Metabolic Syndrome and Related Medical Conditions Comorbid Vascular Disease Comorbid Neurological Conditions Infectious Diseases Cancer Endocrinological Disorders
14 xii Contents Gastroenterological Disorders Disorders of the Blood Respiratory System Disorders Various Comorbid Medical Disorders Genetics and Endophenotypes References Classification and Epidemiology Classification General Considerations Contemporary Classification Systems Contemporary Classification of BD and Related Disorders Epidemiology of BD The Amish Study The Epidemiological Catchment Area (ECA) The National Comorbidity Survey (NCS) The Cross-National Collaborative Group (CNCG) Zurich Switzerland Shatin, Hong Kong Nottingham, UK The Netherlands Study The Australian Study The Butajira Study The Merikangas Study Other Smaller Studies Epidemiology of the Bipolar Spectrum Conclusions on Epidemiology References Disability and Overall Burden Related with Bipolar Disorder Disability Overview and Definitions Disability in BD Patients Quality of Life Caregiver and Family Burden Prevalence of Caregiver Burden Objective Burden Subjective Burden Influence of Sociodemographic Factors on Caregiver Burden Special Topics Related to Caregiver Burden Comparison with Burden Caused by Other Disorders Interventions Caregiver Burden and Patient Outcome
15 Contents xiii 12.4 Cost Stigma References Aetiopathogenesis of Bipolar Disorder Social Theories Psychological Theories Aggression-Turned-Inward Model Object Loss Loss of Self-Esteem Cognitive Model Learned Helplessness Model Depression and Reinforcement Neurobiology of BD Neuroanatomy of BD Functional Studies Neurotransmitters and Receptors Genetic Studies References Psychometric and Neuropsychological Assessment Introduction Psychometric Tools Depression Rating Scales Mania Rating Scales Anxiety Rating Scales Psychotic Symptoms Rating Scales Disability and General Assessment Temperament and Personality Inventories Adverse Events Scales Substance Use Scales Other Rating Scales Neuropsychological Tools References Staging of Bipolar Disorder The Concept of Staging Staging of BD Clinical Determinants of BD Staging Neurobiological Determinants of BD Staging Treatment Data Supporting the Staging Approach Existing Models for the Staging of BD The Model of Berk The Model of Kapczinski The Model of Post The Model of Cosci and Fava The Model of Frank The Future of Staging of BD References
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